Healthcare Provider Details

I. General information

NPI: 1992799092
Provider Name (Legal Business Name): PATRICE FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DRIVE 10TH MEDICAL GROUP
USAF ACADEMY CO
80840
US

IV. Provider business mailing address

4102 PINION DRIVE 10TH MEDICAL GROUP
USAF ACADEMY CO
80840-2502
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-0217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 21874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: